Minnesota offers a variety of health care programs designed to ensure its residents have access to necessary medical services. Among these, Minnesota Health Care Programs (MHCP) stands out as a crucial resource. If you’re navigating the complexities of health coverage, you might be asking, Is Minnesota Health Care Programs Medicaid? This article will delve into what MHCP is, clarify its relationship with Medicaid, and provide a comprehensive guide on how to enroll as a provider.
Minnesota Health Care Programs is indeed the umbrella term for the state’s Medicaid program, along with other state-funded health care options. It serves a diverse population, including children, families, seniors, and people with disabilities, ensuring access to medical, dental, and mental health services. Understanding MHCP is vital for both those seeking coverage and healthcare providers aiming to serve this significant segment of Minnesota’s population.
This guide is designed for healthcare professionals like you at carcodereader.store, who are experts in your field and are looking to expand your services within the Minnesota healthcare landscape. We will walk you through the enrollment process, ensuring you are well-equipped to become an MHCP provider and contribute to accessible healthcare in Minnesota.
Enrollment Process for Minnesota Health Care Programs (MHCP)
Becoming an enrolled MHCP provider allows you to offer your valuable services to a broader range of patients within Minnesota. The process is structured and requires careful attention to detail. MHCP provides resources to assist providers through each step, primarily through the Minnesota Provider Screening and Enrollment (MPSE) portal. For those new to MHCP, quarterly webinars are available, offering detailed guidance on utilizing the MPSE portal for initial enrollment. You can find more information and registration details on the MPSE training website.
To begin your journey as an MHCP provider, follow these essential steps:
1. Examine the Excluded Provider Lists
Before you even begin the application, it’s critical to verify that neither you nor anyone associated with your practice appears on federal or state excluded provider lists. The Office of Inspector General (OIG) within the federal Department of Health and Human Services maintains a list of individuals and entities excluded from participation in Medicare, Medicaid, and other federal health care programs due to fraud, abuse, or other violations. MHCP adheres to these federal exclusions and also maintains its own state-level exclusion list.
MHCP is prohibited from enrolling or paying providers who, or whose employees or contractors, are on these exclusion lists. Engaging with excluded individuals or entities can lead to significant civil monetary penalties from the OIG.
To ensure compliance:
- Pre-Enrollment Check: Search the OIG’s List of Excluded Individuals and Entities (LEIE) before initiating your enrollment application.
- Pre-Hire and Pre-Contract Check: Conduct LEIE searches before hiring any new employees or contracting with any new contractors.
- Monthly Monitoring: Establish a routine of monthly LEIE searches to catch any updates or changes since your last check.
Should your searches reveal any exclusions, it’s imperative to report these findings immediately to MHCP Provider Eligibility and Compliance via fax at 651-431-7462. Further details regarding excluded provider lists can be found on the Excluded Provider Lists page within the MHCP Provider Manual.
2. Confirm Compliance with Rules and Requirements
Eligibility for MHCP enrollment hinges on meeting specific criteria and certifications relevant to the health services you intend to provide. Prior to submitting your enrollment information, ensure you meticulously review and satisfy all necessary prerequisites.
To ascertain these requirements:
- Eligible Providers Section: Refer to the Eligible Providers section on this page. This section outlines licensure and certification necessities categorized by provider type.
- Provider Screening Requirements: Thoroughly examine the Provider Screening Requirements page of the MHCP Provider Manual. This resource provides a comprehensive overview of the screening processes and standards you must adhere to.
Meeting these requirements is not just a formality; it’s a commitment to providing quality care within the MHCP network, ensuring beneficiaries receive the best possible services.
3. Acquire a Provider Identification Number: NPI or UMPI
A crucial step in the enrollment process is obtaining the correct provider identification number. For most providers, this will be a National Provider Identifier (NPI). The NPI is a unique, HIPAA-mandated identification number for healthcare providers. It is used for submitting and processing healthcare claims and other transactions.
If you are eligible for an NPI, you must obtain it before enrolling with MHCP. You can apply for an NPI through the National Plan and Provider Enumeration System (NPPES).
Unique Minnesota Provider Identifier (UMPI)
Certain provider types, while not mandated to have an NPI, may still possess one. However, if you fall into one of the categories below and do not have an NPI, you can still enroll. MHCP will assign you a Unique Minnesota Provider Identifier (UMPI) after your application is processed. These provider types include:
- Home and community-based services providers
- Personal care provider organizations providers
- Day training and habilitation providers
- Early intensive developmental and behavioral intervention (EIDBI) Level II and III individuals
- Nonemergency medical transportation (NEMT) organizations
- Doula providers (Individual and organizational providers)
Providers who do not meet the HIPAA definition of a health care provider may not be eligible for an NPI. In such cases, you can still apply for MHCP enrollment. Upon approval, MHCP will send a Welcome letter containing your assigned 10-digit UMPI.
The following provider types are not eligible to obtain an NPI before enrollment and will be assigned a UMPI by MHCP:
- Approved day treatment centers
- Children’s residential services providers
- Clearinghouses and billing intermediaries – (Note: Not eligible to enroll as an MCO-only provider)
- Health care case coordinators
- Individual personal care assistants (PCAs)
- Community health workers
- Women, Infants and Children (WIC) programs
- Head Start programs
- Electronic Data Interchange (EDI) trading partners – (Note: Not eligible to enroll as an MCO-only provider)
- Clearing houses – (Note: Not eligible to enroll as an MCO-only provider)
- Billing intermediaries – (Note: Not eligible to enroll as an MCO-only provider)
- Non-emergency medical transportation (NEMT) drivers
Whether you use an NPI or a UMPI, this provider identification number is mandatory for all fee-for-service claims submitted to MHCP. It is the key to ensuring accurate billing and timely payment for services rendered to MHCP members.
4. Submitting Your Enrollment Documents to MHCP
With your provider identification number in hand and all prerequisites met, you can proceed to submit your enrollment documents. MHCP offers two convenient methods for submission:
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Online Submission via MPSE Portal: The most efficient and recommended method is to use the Minnesota Provider Screening and Enrollment (MPSE) portal. Register for access and complete the enrollment process online. The MPSE portal offers several advantages, including:
- Built-in guidance throughout the application process.
- Real-time error detection to minimize application mistakes.
- Application status tracking to monitor progress.
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Fax Submission: Alternatively, you can complete the required paper documents and fax them to MHCP’s Provider Eligibility and Compliance division. To determine the specific forms required for your provider type, refer to the Eligible Providers section and click on the link for your service type.
Important Note: MHCP does not accept enrollment documents via email. All submissions must be made through either the MPSE portal or by fax.
Application Fees for MHCP Enrollment
Certain MHCP provider types are required to pay a nonrefundable application fee. This fee applies to new enrollments, re-enrollments, and revalidations. If applicable to your provider type, payment must be remitted before submitting your enrollment application. To check if an application fee is required for your provider type and to understand the fee structure, consult the Application Fees section within the Provider Screening Requirements page of the MHCP Provider Manual.
Electronic Funds Transfer (EFT) for Payments
MHCP strongly encourages all fee-for-service providers to enroll in Electronic Funds Transfer (EFT), also known as direct deposit, for payment disbursement. EFT offers a secure, efficient, and faster alternative to paper checks. You can initiate EFT enrollment during the application process itself – there’s no need to wait for enrollment approval.
Benefits of EFT payments:
- Faster Access to Funds: EFT payments are deposited directly into your bank account, eliminating mail delays and bank deposit trips.
- Enhanced Security: Reduce the risk of lost, stolen, or misdirected paper checks.
- Streamlined Cash Flow: Minimize paperwork and simplify cash flow management.
To receive EFT payments from MHCP, you’ll need an active 10-digit supplier ID and a 3-digit supplier location code from Minnesota Management and Budget (MMB).
Steps to establish a supplier ID for MHCP EFT payments:
- Supplier Portal Registration: Visit the Minnesota Supplier Portal website. If you don’t already have a supplier ID, register as a “New Supplier” by selecting “Register for an Account.”
- Add or Update Banking Information: To add or modify banking details for an existing supplier ID, refer to the Update Supplier Profile guide or submit the MMB EFT Bank Change Request (PDF). For questions regarding your supplier ID’s direct deposit status, contact MMB at 651-201-8106.
- Activation Period: Allow 10 business days for your banking information to become active within the supplier portal. Once active, input your EFT supplier ID and supplier location code via the MPSE portal (instructions are in the MPSE user manual under Enrollment Record Information) or fax a completed EFT Supplier ID Notification (DHS-3725) (PDF) to Provider Eligibility and Compliance at 651-431-7462.
Enrollment for Managed Care Organization (MCO) Providers
Federal mandates under the 21st Century Cures Act necessitate that state agencies, like the DHS in Minnesota, enroll all Medicaid providers. This encompasses providers in both fee-for-service Medicaid and Managed Care Organization (MCO) networks. Enrollment for MCO in-network only providers commenced on July 17, 2023.
To enroll as an MCO in-network provider, follow the same Enrollment Process steps outlined earlier. For additional details, consult Enrollment process for MCO network providers. The Eligible Providers section lists the provider types DHS enrolls and their specific enrollment requirements.
Note: If you are already an active fee-for-service provider and also contract with an MCO, you are not required to repeat the screening and enrollment process.
Providers opting to participate in an MHCP managed care organization network must also directly contact the relevant health plan for network participation and contract specifics. Further information on MCOs can be found on the MCOs page within the MHCP Provider Manual.
For MCO in-network provider enrollment instructions within the MPSE User Manual, refer to the MCO In-Network Provider Enrollment page.
Enrollment Approvals: Minnesota and Out-of-State Providers
Approval for Minnesota-Based Providers
MHCP offers retroactive approvals for Minnesota-based providers. If you meet all enrollment criteria for your provider type, your application will be approved with an effective date determined by the most favorable of the following:
- The effective date you requested in MPSE or on your application.
- The first day of the month in which MHCP received your enrollment request.
- Up to 90 days prior to your Medicare certification effective date.
- The retroactive date of the member’s confirmed MHCP eligibility.
- The date you are confirmed to have met all MHCP provider requirements.
For provider types requiring additional screening, such as site visits and background checks (listed as moderate or high-risk on the Risk Levels section of the Provider Screening Requirements page), approval will be granted upon completion of these screenings.
Approval for Out-of-State Providers
Out-of-state providers can apply for MHCP enrollment specifically for dates of service provided to an MHCP member. To qualify for payment, out-of-state providers must:
- Adhere to the licensing and certification standards of their state of location. (Exception: Home and community-based waiver services providers must meet Minnesota’s waiver plan requirements).
- Submit an enrollment request via the MPSE portal with a copy of the Provider Agreement, required assurance statements, and credentials. Alternatively, fax these documents to Provider Eligibility and Compliance at the fax number on the MHCP forms.
For further details on requirements, consult the Billing Policy Overview and Out-of-State Providers sections in the MHCP Provider Manual.
Consolidated Providers and Taxonomy Codes
A consolidated provider is defined as a provider with multiple enrollment records linked to a single National Provider Identifier (NPI). While a provider may offer diverse services, billing all services under one enrollment record isn’t always feasible. Multiple enrollment records might be necessary based on the service types offered. Provider Eligibility and Compliance reviews provider types and credentials for consolidation opportunities.
MHCP Use of Taxonomy Codes (Fee-for-Service Only)
A taxonomy code categorizes a provider by type, classification, and specialization. Taxonomy codes and descriptions are available on the X12 External Codes List webpage.
When a provider utilizes one NPI for multiple records (due to multiple locations or service types), MHCP consolidates these under a provider type (PT) 33 record, while maintaining the linked active records.
- Shared Physical Address: If multiple records under one NPI share a physical address or zip code, taxonomy codes for each record are required post-enrollment and MN–ITS registration. If records are limited to and share a taxonomy code, a custom taxonomy code can be entered. MHCP uses taxonomy codes for billing purposes only.
- Unique Physical Addresses: If records under one NPI have unique physical addresses, the service facility location must be submitted on claims.
Taxonomy or custom taxonomy codes must be submitted to MHCP via MN–ITS. A tutorial video on Adding Taxonomy Codes is available for consolidated providers.
MN–ITS Registration for Fee-for-Service Providers
MN–ITS (Minnesota Information Transfer System) is a free, HIPAA-compliant, web-based system essential for MHCP providers. Upon enrollment approval, Provider Eligibility and Compliance will send a Welcome letter containing your initial MN–ITS User ID and Password. Providers enrolling via fax will need to register for MN–ITS using the provided registration instructions. MPSE portal enrollees can use the login details from the Welcome letter to access MN–ITS.
Minnesota law mandates electronic claims submission for all MHCP-eligible healthcare providers and suppliers. Paper claims are not processed.
MN–ITS functionalities include:
- Verifying program eligibility for MHCP members.
- Retrieving enrollment-related letters and notices.
- Submitting authorization requests for medical, dental, or medical supplies.
- Submitting service agreement (SA) requests for home care services.
- Retrieving authorization and service agreement letters.
- Submitting claims (including claims with third-party insurance or Medicare).
- Copying or replacing incorrectly submitted paid claims.
- Checking claim status.
- Accessing the MN–ITS Mailbox for Remittance Advices (RAs) and other communications.
- Accessing MPSE to manage enrollment records.
MN–ITS Registration for MCO In-Network Only Providers
MCO in-network only providers also need to register for MN–ITS. Upon MHCP application approval, a Welcome letter with MN–ITS login credentials and registration instructions will be sent. MCO in-network providers primarily use MN–ITS to access the MPSE portal for managing MHCP enrollment information and retrieving enrollment-related communications.
Managing Changes to Your Enrollment
Maintaining up-to-date enrollment information is a provider’s responsibility. The most efficient way to report changes is through the MPSE portal. MHCP also offers quarterly webinars on managing enrollment changes via MPSE, accessible through the MPSE Training site.
Alternatively, you can fax changes using the following forms:
- Individual Practitioner MHCP Provider Profile Change Form (DHS-3535) (PDF): For individual enrollment information or affiliation changes.
- Organization MHCP Provider Profile Change Form (DHS-3535A) (PDF): For organization contact or enrollment information updates.
- Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF): For changes in management, board, or ownership.
- Electronic Remittance Advice (RA) Request Form (DHS-4087) (PDF): (Fee-for-service only) For adding electronic RA or managing RA affiliations.
- EFT bank change form (PDF): For direct deposit information changes (submitted to MMB, not DHS).
- EFT Supplier ID Notification (DHS-3725) (PDF): (Fee-for-service only) For MMB-issued EFT Vendor Number or Location Code changes.
- Provider Entity Sale or Transfer Addendum (DHS-5550) (PDF): For reporting ownership changes due to sale or transfer. Submit with new enrollment documents at least 30 days prior to the sale date. Note: Change of ownership may lead to payment reversals for terminated providers.
Provider Eligibility and Compliance will process change requests and contact you if further documentation is needed. Enrollment status letters are sent to providers upon changes in participation.
Processing Timelines and Actions
Provider Eligibility and Compliance aims to process complete enrollment requests within 30 days of receipt, regardless of submission method (MPSE or fax). This 30-day timeline applies equally to new, corrected, and resubmitted requests.
Complete Requests
A complete request includes all required fields and documents. MPSE users can track request statuses and outcomes in the Request Submitted and Next Steps section of the user manual.
For incomplete new enrollment requests, a request for more information (RFMI) letter will be sent via MN–ITS mailbox or U.S. mail. You have 60 days to respond with the missing information using the original submission method (MPSE or fax – do not mix methods). Failure to provide complete information within the initial 60 days may result in a second RFMI with an additional 30-day deadline. Continued incompleteness after this period will lead to request denial.
For submissions requiring corrections or additional information, allow up to 30 days from the most recent submission date for processing.
Inactive Enrollment Records
If your enrollment record becomes inactive, re-enrollment with MHCP is necessary. You can re-enroll via the MPSE portal or by faxing a new application.
Billing Organizations for Claims Submission
MHCP-enrolled providers can utilize clearinghouses or billing intermediaries to submit claims and transactions electronically. These billing agents must enroll as a billing organization.
Eligible Providers for MHCP
To participate in MHCP, providers must meet professional certification and licensure requirements according to state and federal regulations relevant to their services. Once these are met, application for MHCP enrollment can be made via the Minnesota Provider Screening and Enrollment (MPSE) portal or by faxing required documents. Contact your contracted Managed Care Organizations (MCOs) for their specific enrollment requirements.
Fee-for-service providers marked with ‘¹’ below do not receive direct payment and must bill through an organization. Providers marked with ‘²’ are ineligible for MCO-only enrollment.
Eligible Health Care Provider Types for MHCP Enrollment:
| ### Organization Providers | ### Individual Providers |
|---|---|
| Adult Day Treatment – 46 | Acupuncturist – AP |
| Allied Oral Health Professional Group – 31 | Alcohol and Drug Counselor – DC |
| Ambulatory Surgical Center – 22 | Allied Oral Health Professional– 31 |
| Birthing Center – B1 (Contact the MHCP Provider Resource Center) | Audiologist – 43 |
| Certified Registered Nurse Anesthetist Organization – 67 | Certified Mental Health Rehabilitation Professional¹- 26 |
| Child and Teen Checkup Clinic – 16 | Certified Nurse Midwife – 66 |
| Children’s Residential Treatment Facility¹- 06 | Certified Professional Midwife – C1 |
| Community First Services and Supports (CFSS) – CFSS | Certified Registered Nurse Anesthetist – 67 |
| Community Health Clinic – 58 | Chiropractor – 37 |
| Community Mental Health Center – 10 | Clinical Nurse Specialist – 68 |
| County Case Manager²- 23 | Community Health Worker¹ – 55 |
| County Human Services Agency² – 45 | Dentist – 30 |
| Day Training and Habilitation for ICF/DD– 19 | Direct Support Worker, Individual¹, ² – 38 |
| Dental Group – 30 | Doula – DA |
| Doula Entity – DA | Early Intensive Developmental and Behavioral Intervention² – EI |
| Durable Medical Equipment – 76 | Health Care Case Coordinator – 27 |
| Early Intensive Developmental and Behavioral Intervention² – EI | Hearing Aid Dispenser – 77 |
| Electronic Data Interchange (EDI) Trading Partner² – 28, 95, 98 | Home Care Nurse – 64 |
| Family Planning Agency – 54 | Licensed Independent Clinical Social Worker – 14 |
| Federally Qualified Health Center – 52 | Licensed Marriage and Family Therapist – 25 |
| Home and Community-Based Services (HCBS) – 18 | Licensed Professional Clinical Counselor- 63 |
| Moving Home Minnesota – 18 | Licensed Psychologist – 42 |
| Housing Stabilization Services – 18-HSS | Nurse Practitioner – 65 |
| Housing Support Supplemental Services – 18 | Occupational Therapist – 29 |
| Home Care Nursing Agency Group – 64 | Optometrist – 35 |
| Home Health – 60 | Pharmacist¹ – 70 |
| Hospice – 02 | Physical Therapist – 39 |
| Hospital – 01 | Physician – 20 |
| Independent Diagnostic Testing Facility – 32 | Physician Assistant – 69 |
| Independent Laboratory – 80 | Podiatrist – 36 |
| Independent X-ray – 81 | Registered Dietician or Licensed Nutritionist – 15 |
| Indian Health Services – 51 | Speech-Language Pathologist – 40 |
| Individualized Education Program – 09 | Transportation Driver¹ – DR |
| Institution for Mental Disease¹ – 03 | |
| Intensive Residential Treatment Services – 50 | |
| Intermediate Care Facilities – 05 | |
| Medical Services Group – 49 | |
| Medical Transportation – 82 | |
| Mental Health Group – 34 | |
| Non-Profit Dental Organization | |
| Nursing Facility – 00 | |
| Optical Company – 75 | |
| Personal Care Provider Organization² – 38 | |
| Pharmacy¹ – 70 | |
| Psychiatric Residential Treatment Facility – PR | |
| Physician Clinic – 20 | |
| Public Health Clinic – 57 | |
| Public Health Nursing Organization – 61 | |
| Recovery Community Organization – RC | |
| Recuperative Care Services – RE | |
| Regional Treatment Center – 17 | |
| Rehabilitation Agency – 11 | |
| Rehabilitation Group – 48 | |
| Renal Dialysis Center – 04 | |
| Rural Health Clinic – 53 | |
| Substance Use Disorder – 62 | |
| Targeted Case Management – 44 or 18 | |
| Transportation Coordinator² – 72 (Contact the MHCP Provider Resource Center) |
